Provider Demographics
NPI:1083830350
Name:FANOUS, ASHRAF F (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:F
Last Name:FANOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 THE MARK LN UNIT 1702
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7166
Mailing Address - Country:US
Mailing Address - Phone:571-232-6708
Mailing Address - Fax:
Practice Address - Street 1:8775 AERO DR STE 238
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1756
Practice Address - Country:US
Practice Address - Phone:571-232-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA890462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry